COVID19-related and all-cause mortality risk among middle-aged and older adults across the first epidemic wave of SARS-COV-2 infection: a population-based cohort study in Southern Catalonia, Spain, March–June 2020

  1. Angel Vila-Corcoles
  2. Eva Satue-Gracia
  3. Angel Vila-Rovira
  4. Cinta de Diego-Cabanes
  5. Maria Jose Forcadell-Peris
  6. Immaculada Hospital-Guardiola
  7. Olga Ochoa-Gondar
  8. Josep Basora-Gallisa

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Abstract

Background

Direct and indirect COVID19-related mortality is uncertain. This study investigated all-cause and COVID19-related deaths among middle-aged and older adults during the first wave of COVID-19 pandemic period, assessing mortality risks by pre-existing socio-demographic and medical underlying conditions.

Methods

Population-based cohort study involving 79,083 individuals ≥50 years-old in Tarragona (Southern Catalonia, Spain). Baseline cohort characteristics (age/sex, comorbidities and medications/vaccinations history) were established at study start (01/03/2020) and main outcomes were COVID19-related deaths (those occurred among patients with laboratory-confirmed COVID19) and all-cause deaths occurred among cohort members between 01/03/2020–30/06/2020. Mortality risks were assessed by Cox regression analyses.

Results

Cohort members were followed for 1,356,358 persons-weeks, occurring 576 all-cause deaths (124 COVID19-related deaths). Of the 124 deceased patients with a laboratory-confirmed COVID19, 112 (90.3%) died by (due to) COVID-19, while 12 (9.7%) died with COVID-19 (but likely due to other concomitant causes). All-cause mortality rate among cohort members across study period was 42.5 deaths per 100,000 persons-week, being 22.8 among healthy/unrelated-COVID19 subjects, 236.4 in COVID19-excluded/PCR-negative subjects, 493.7 in COVID19-compatible/PCR-unperformed subjects and 4009.1 in COVID19-confirmed patients. Increasing age, sex male, nursing-home residence, cancer, neurologic, cardiac or liver disease, receiving diuretics, systemic corticosteroids, proton-pump inhibitors and benzodiazepines were associated with increased risk of all-cause mortality; conversely, receiving renin-angiotensin inhibitors and statins were associated with reduced risk. Age/years (hazard ratio [HR]: 1.08; 95% confidence interval [CI]: 1.06–1.10), sex male (HR: 1.82; 95% CI: 1.24–2.70), nursing-home residence (HR: 12.56; 95% CI: 8.07–19.54) and number of pre-existing comorbidities (HR: 1.14; 95% CI: 1.01–1.29) were significant predictors for COVID19-related mortality, but none specific comorbidity emerged significantly associated with an increased risk in multivariable analysis evaluating it.

Conclusion

COVID19-related deaths represented more than 20 % of all-cause mortality occurred among middle-aged and older adults during the first wave of the pandemic in the region. A considerable proportion (around 10 %) of these COVID19-related deaths could be attributed to other concomitant causes. Theoretically COVID19-excluded subjects (PCR-negative) suffered ten-times greater all-cause mortality than healthy/unrelated-COVID19 subjects, which points to the existence of considerable number of false negative results in earlier PCR testing and could explain part of the global excess all-cause mortality observed during the pandemic.

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  1. Version published to 10.1186/s12889-021-11879-2
  2. ScreenIT

    SciScore for 10.1101/2021.02.02.21251028: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: The study was approved by the Ethical Committee of the Institution (Ethics Committee IDIAP Jordi Gol, Barcelona, file 20/065-PCV) and was conducted in accordance with the general principles for observational studies.[
    Consent: 17] The study was determined to be exempt for informed consent under the public health surveillance exception.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    The analyses were performed using IBM SPSS Statistics for Windows, version 24 (IBM Corp.,
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Major limitations in this study are related with its retrospective design and scarce availability of PCR tests during the first weeks of study period. Indeed, considering that PCR testing was not routinely performed for all clinically compatible/suspected COVID19 patients across the study period, the laboratory-confirmed COVID19 cases (and, consequently, the number of COVID19-related deaths) were likely underestimated. Then, all-cause mortality (which is not influenced by the frequency of PCR testing) may be a better measure of COVID19 pandemic impact. As another limitation, the study was conducted in a single geographical area and, logically, specific mortality data may not be directly extrapolated to other geographical regions with distinct epidemic conditions. The authors recognise these inherent limitations but note that, opposite to many papers reporting only crude COVID19 data, the present study provides age&sex-adjusted and multivariable-adjusted data evaluating both all-cause and COVID19-related mortality risks. Importantly, the estimations may considerably vary depending on type of analyses/adjustments performed; therefore, we underline again the importance of maximizing adjustments. We did subgroup analysis (nursing-home/community-dwelling) and multivariable-adjustments, but, as in all observational studies, a residual confounding due to unmeasured factors (e.g., socio-economical, lifestyle, job-or healthcare-related factors) cannot be excluded.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  3. Version published to 10.1101/2021.02.02.21251028v1 on medRxiv